15 January 2017

American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity, 2016.

The combined prevalence of overweight and obesity is 71% in adults, and up to 50 - 80% of obese men have testosterone deficiency (also known as hypogonadism). The most common comorbidity among the growing obese population is type 2 diabetes; about half of all men with type 2 diabetes have hypogonadism.

Recent clinical guidelines on hypogonadism state that increased visceral (also known as intra-abdominal) body fat and obesity are signs of hypogonadism, and that testosterone should be assessed in men with obesity, metabolic syndrome and diabetes. However, due to the epidemic prevalence of overweight/obesity and related metabolic diseases, the large majority of hypogonadal men will see a primary care physician and/or a diabetologist or cardiologist, who is likely not aware of the clinical guidelines on hypogonadism.

It is therefore laudable that The American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity in their 2016 revision dedicated two comprehensive sections on testosterone deficiency and treatment. Here we summarize these AACE / ACE recommendations.

Key Points

All men who have an increased waist circumference (≥102 cm) or who have obesity (BMI ≥30 kg/m²) should be assessed for hypogonadism by history and physical examination and be tested for testosterone deficiency; all men with hypogonadism should be evaluated for the presence of overweight or obesity.

All men with type 2 diabetes should be tested to exclude testosterone deficiency.

Treatment of hypogonadism in men with increased waist circumference or obesity should include weight-loss therapy. Weight loss of more than 5 to 10% is needed for significant improvement in serum testosterone.

Men with hypogonadism and obesity who are not seeking fertility should be considered for testosterone therapy in addition to lifestyle intervention, since testosterone in these patients results in weight loss, decreased waist circumference, and improvements in metabolic parameters glucose, HbA1C, lipids, and blood pressure).

In 2010, the Endocrine Society published a Clinical Practice Guideline “Testosterone Therapy in Adult Men With Androgen Deficiency Syndromes”, which addressed important issues regarding the diagnosis and treatment of male hypogonadism.

Since publication of this Guideline, several high-quality trials have been conducted, warranting an update of the 2010 recommendations in several areas, especially that of testosterone therapy in men with the metabolic syndrome, type 2 diabetes, sexual dysfunction, and frailty. In addition, many of the previously stated contraindications to testosterone therapy – including severe lower urinary tract symptoms (LUTS) and untreated obstructive sleep apnea (OSA) - have been reexamined in recent trials.

Here we summarize the results of a systematic analysis of the latest high-quality studies, which call for some important updates of the 2010 Endocrine Society Clinical Practice Guidelines for Male Hypogonadism.

Sex hormone binding globulin (SHBG) is a “hormone carrier” that binds and transports testosterone in the blood. It is well established that both low total testosterone and low SHBG levels are associated with an increased risk of existing and incident metabolic syndrome in men.

However, it is still debated whether testosterone and SHBG are independently associated with incident development of the metabolic syndrome. In addition, the potential role of estradiol (the main estrogen) in this association is unknown. A recently published study specifically investigated these issues, using data from the European Male Aging Study (EMAS), a prospective study of aging in European men.

The role of testosterone in the etiology and treatment of obesity, the metabolic syndrome, and diabetes mellitus type 2. Saad F, Gooren LJ. Journal of obesity. 2011;2011.

It is well documented that obesity may cause hypogonadism, and that hypogonadism may cause obesity. This has generated debate about what condition comes first; obesity or hypogonadism? And what should be the first point of intervention?

In this editorial we summarize data from several reviews on the association of obesity and hypogonadism, and make the case that obesity and hypogonadism create a self-perpetuating vicious circle. Once a vicious circle has been established, it doesn’t matter where one intervenes; one can either treat the obese condition or treat hypogonadism first. The critical issue is to break the vicious circle as soon as possible before irreversible health damage arises.

Nevertheless, as we will explain here, treating hypogonadism first may prove more effective in that it to a large extent “automatically” takes care of the excess body fat and metabolic derangements, and also confers psychological benefits that will help obese men become more physically active. Thereby, restoring testosterone levels in hypogonadal obese men will relatively quickly break the self-perpetuating vicious circle, and transform it into a “health promoting circle.”

22 April 2013

Whilst metabolic syndrome is known to be directly associated with a number of cardiovascular diseases and type 2 diabetes there is now growing evidence of its influence on the initiation and clinical progression of prostatic diseases such as benign prostatic hyperplasia (BPH) and prostate cancer (PCa). A recent review of the scientific literature evaluated studies providing evidence of the role of metabolic syndrome in the development and progression of BPH and PCa. In this evaluation the authors considered relevant articles published between 1995 and September 2011 that were identified using one of the main scientific citation databases – PubMed.

2 April 2012

This article reviewed what is known about the consequences of low testosterone (also known as hypogonadism) in middle-aged and older men, with practical information on the benefits and risks of testosterone replacement. The authors examined evidence from a wide range of studies about low testosterone and its treatment to prepare their review.

8 March 2012

This review discussed the relationship between low testosterone level and frailty in elderly men and evaluated the evidence which shows that testosterone replacement therapy improves the physical functioning and quality of life of elderly frail men with confirmed low testosterone levels.